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Concordance of Chest Radiography and Chest Computed Tomography Findings in Patients with Hematologic Malignancy and

Sebastian Wurster1, Sung-Yeon Cho1,2,3, Hazim Allos1

  • 1Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

Journal of Fungi (Basel, Switzerland)
|October 25, 2024
PubMed

Insights

Invasive pulmonary mucormycosis (IPM) diagnosis in hematological malignancy patients relies on imaging. Chest X-rays may not always show lesions seen on CT scans, potentially impacting mortality risk.

Area of Science:

  • Medical Mycology
  • Radiology
  • Hematology Oncology

Background:

  • Invasive pulmonary mucormycosis (IPM) is a life-threatening opportunistic infection.
  • Patients with hematological malignancies (HM) are particularly vulnerable to IPM.
  • Accurate and timely diagnosis of IPM is critical for patient outcomes.

Purpose of the Study:

  • To compare the visualization of IPM lesions on chest computed tomography (CCT) versus chest X-ray (CXR).
  • To assess the prognostic significance of discordant imaging findings between CCT and CXR in HM patients with IPM.
  • To identify independent risk factors and protective factors for mortality in IPM patients.

Main Methods:

  • Retrospective review of 44 HM patients with probable/proven IPM.
  • Concurrent CCT and CXR studies were analyzed for IPM lesion detection.
  • Statistical analysis, including multivariable analysis and log-rank test, was used to determine prognostic significance.

Main Results:

  • All patients had abnormal CCT findings, while 89% had abnormal CXR findings.
  • Only 59% of CXR studies showed lesions matching CCT findings.
  • Higher Acute Physiology and Chronic Health Evaluation II score and breakthrough antifungal infection were independent risk factors for mortality.
  • Absence of neutropenia, neutrophil recovery, and surgical revision were protective factors.

Conclusions:

  • Discordant imaging between CCT and CXR in IPM may be associated with increased mortality.
  • CXR may underestimate the extent of IPM lesions compared to CCT.
  • Radiologic lesion kinetics could serve as a prognostic staging tool for IPM.
Keywords:
chest X-raychest computed tomographyhematological malignancylung infectionmortalitymucormycosisneutropeniaprognosisradiologic imaging

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